Secrets of Dallas’ dead

Autopsies give glimpse into how Dallas County residents died — and how they lived

Published February 26, 2018

Suicide, homicide, drug overdose, disease, just plain old age — the way people die in Dallas is as unique as people themselves.

At The Dallas Morning News, we took a deep look at five years of reports from the Dallas County medical examiner to try to better understand how people in Dallas die, and what that says about how we live.

Here is some of what we learned:

White men over 50 committed suicide three times as often as any other race or ethnicity.

More than 30 infants have died as the result of bedsharing with an adult or another child. Eighty percent of them were black or Hispanic.

Blacks most frequently had their deaths ruled “undetermined” manner and cause of death by the medical examiner’s office.

Heroin is more prevalent in accidental drug deaths overall, but cocaine is far more prominent in the deaths of blacks than any other race or ethnicity.

Black men account for nearly half of all Dallas County homicide victims, but blacks make up only about a quarter of the population.

Not all people who die undergo an autopsy. Since 2012, about 75,000 people died each year in Dallas County.

Only a fraction of those were autopsied by the Southwestern Institute of Forensic Sciences, the formal name for the Dallas County medical examiner’s office.

From Jan. 1, 2012, to Dec. 31, 2017, about 12,000 autopsies were performed by the medical examiner, accounting for about 23 percent of total reported deaths in Dallas County.

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Genetics vs. geography

Researchers long ago concluded that your ZIP code plays as important a role as your genetic code in preventable conditions such as heart disease and diabetes.

Though a person can’t change family history of a disease, access to health-care providers and health education are largely determined by where a person lives.

A 2016 study, which examined the role of racial, economic and educational factors in life expectancy, as well as outcomes for new mothers and their babies, showed that average life expectancies in some communities were 20-30 years shorter than those “mere miles” away. Gaps in health care were the result of income inequality as well as racial, economic and geographical segregation.

Although focused on disparities on a nationwide scale, studies such as these are still applicable at a community level.

A doctor for the dead

Dallas County Medical Examiner Jeffrey Barnard and his 13 staff members perform more than 3,000 autopsies each year. Most of the time, they do their work in relative obscurity. Read more >>

The North-South gap

Most of the murders committed in Dallas over the past five years have occurred in minority low-income neighborhoods in southern Dallas.

From 2012-17, 1,473 deaths in Dallas County were ruled homicides. Fifty-four percent of victims were black; 46 percent were black men.

A divided Dallas: Race by Dallas County ZIP codes

The darker the area on the map, the higher the concentration of a race/ethnicity in a ZIP code.

White

Black

Hispanic

Deaths by Dallas County ZIP codes, 2012-17

Use the dropdown to select a ZIP code. Use the checkboxes to toggle display of homicides (green) and suicides (orange) on the map. Hover over the map to reveal more information about individual deaths.

Homicides

Suicides

SOURCES: Southwestern Institute of Forensic Sciences, ESRI

Dallas’ deadliest ZIP codes close to areas of wealth

Just a few miles from the eateries and shops of Bishop Arts District, in southern Dallas' 75216 ZIP code, 24 people were killed per 10,000 residents. There were 117 murders here from 2012-17. This pales in comparison to adjoining ZIP code 75215, where more than double the number of people were murdered per 10,000 residents. Here, there were 84 murders, just six miles from the gentrifying Trinity Groves.

Suicide most likely among wealthy white men

While suicide rates for blacks and Hispanics have remained relatively flat in the past 15 years, suicides among whites have been on an upward trajectory since 2000. The bulk of suicides were committed in northern Dallas and in some of the county’s whitest, most affluent neighborhoods, especially for men over 50. From 2012-17, the average age for white suicides was 52.

Sleep-related infant deaths hit black communities hard

Sudden Unexpected Infant Death (SUID) is a category that includes deaths of infants under a year old with no clearly explained cause. This includes what’s commonly known as SIDS, or Sudden Infant Death Syndrome.

Since 2012, at least 98 babies' deaths have been ruled SUID deaths. Of those, 81 percent were black or Hispanic. One-third of these deaths were ruled the result of bed-sharing. The children ranged in age from 9 days to 6 months.

Blacks account for most ‘undetermined’ deaths

For 244 deaths over the period examined, the county medical examiner could find no clear cause of death. This happens when medical examiners don’t have enough information to make a determination on the cause of death. In some cases that’s because they don’t have enough body parts, the body is too decomposed or there is inadequate information about the person’s death even after an investigation. Undetermined cause and manner of death disproportionately affect minorities, especially blacks. Roughly 44 percent of all undetermined decedents were black. It’s unclear why those communities had more undetermined deaths.

‘Undetermined’ deaths by Dallas County ZIP code, 2012-17

Hover over the map to reveal more information about individual deaths.

White

Black

Hispanic

Asian

SOURCES: Southwestern Institute of Forensic Sciences, ESRI

Drug-related deaths

In 2016, Texas had the third lowest drug overdose rate in the U.S., ahead of only South Dakota and Nebraska, according to the Centers for Disease Control and Prevention. Drug toxicity and overdose has been the leading cause of fatal accidents in Dallas County for the past five years, even outpacing car crashes, said the CDC. In some cases, Dallas County rates of drug deaths overtook Harris County rates.

Drug toxicity and overdose has been the leading cause of accidental deaths in Dallas County for the past five years.

An analysis of the types of drugs the medical examiner ruled a primary or contributory cause of death revealed trends among several drugs.

Heroin: There were more than 1,800 heroin deaths processed by the Dallas County medical examiner’s office — overwhelmingly whites — from 2012-2017. Heroin was, by far, the drug that most frequently killed people in Dallas County.

Cocaine: While heroin deaths are most common overall, cocaine is far more prevalent in the deaths of blacks. This is on par with a national trend. Maryland researchers compared drugs involved in overdoses for blacks, whites and Hispanics from 2000-15. Between 2012 and 2015, cocaine-related deaths among black men were as common as heroin — and prescription opioid-related deaths among white men.

Amphetamine/methamphetamine: Methamphetamine was ranked the top drug threat in the Dallas area in 2015, according to the Drug Enforcement Agency.In 2017, the Dallas County rate of meth deaths per 100,000 — 3.61 — was more than twice the rate in Harris County.

METHODOLOGY

All autopsy data for this project was obtained from the Dallas Southwestern Institute of Forensic Sciences, Harris County Institute of Forensic Sciences and Tarrant County Medical Examiner’s Office for deaths occurring from Jan. 1, 2012, to Dec. 31, 2017. Those with pending causes of death during this period were excluded from counts. Demographic and geographic data were obtained from the Texas Department of State Health Services (DSHS) and ESRI 2016 residential ZIP code shapefiles.

Pursuant to state law, all people who died as a result of a fatal accident of any kind, suspected suicide or homicide, died in police custody or were under age 6 were required to have an autopsy performed. Natural deaths were purposefully excluded from this analysis because, unlike fatal accidents, suicides and homicides, not all natural deaths are autopsied by the medical examiner.

Homicides: The ZIP code of injury was used to calculate the homicide rate. Zip codes 75260 and 75270 were omitted because they are postal codes with no residents. ZIP codes 75247, 75202, 75251, 75246, 752226 and 75210 in Dallas, 75141 in Hutchins and 75182 in Sunnyvale were omitted because they have fewer than 10,000 residents. Additionally, 185 records were not counted because they had no ZIP code of injury listed.

Undetermined: Fifty-eight records were omitted from the map due to incomplete or no geographical information provided.

Drugs: Prescription opioid drugs (codeine, fentanyl, hydrocodone, methadone and oxycodone) were separated out into individual counts by race because, in many instances, victims had more than one opioid drug listed as a cause of death. Separation was intended to prevent false inflation of opioid use by users of multiple drugs.

Not all death certificates for unintentional overdoses include a contributing drug. The Maryland researchers mentioned above who studied cocaine and opioid use among whites and blacks said this number is roughly 20 percent and could result in gross underestimates of drug deaths.

Race classifications: Native American/American Indian data was included when available. Harris County's data didn’t include a classification for Native American/American Indian. When the data was available, the term “Native American” was used because that’s how these persons were identified in the data.